A man for all seasons

After more than 20 years living in Uganda, the doctor from South Armagh couldn’t take it any more.

And so came the decision to run for office. After a landslide victory in which he took over 60% of the vote, he is now mayor of the Makindye Division of Kampala, where he represents about one fifth of the capital’s population, some 400,000 people.

The roads still need repair, but he thinks he’s winning the battle. From his office on a hilltop in the International Hospital Kampala, Clarke fights against the potholes, petty corruption, and red tape that drove him into office.

Clarke is small and wiry, his gaunt face a reminder of his brush with death 20 years ago, when he had testicular cancer which doctors feared would be fatal. Nevertheless, the 60-year-old has an energy his young staff struggles to match. Brenda Naluyima, his political assistant, says keeping up is a daily challenge.

“If you’re going to be working for Ian, you need to able to think for yourself and think pretty quickly… Sometimes you feel like slowing him down. Every two seconds he has a new project and you’re supposed to be able to adapt within a few seconds on a daily basis. And once he’s made up his mind, there’s no possibility of getting him to see things from a different perspective.”

It came as a shock to many, not least his rivals, that “the Irish doctor”, as he is universally known, was elected mayor last summer. He overcame many weaknesses — including an inability to speak the dominant local language, Luganda. A video of one of his election rallies shows him standing in front of a bemused crowd, reading a prepared script in Luganda, while a translator stands by to interpret when things get complicated. “Does anyone know where Ireland is?” the candidate shouts into a microphone. The crowd goes silent.

Makindye, just south-east of the city centre, comprises both palatial hilltop houses (including the Clarke family home) and vast, notoriously filthy, shanty towns. At the bottom of the hill where International Hospital Kampala is based, lies Namowongo slum, where tens of thousands of people live in precarious shelters made of debris. The area has a complete lack of public services, and is plagued by unemployment, HIV, and drug abuse.

Strewn along the muddy paths where children play are small polythene bags containing human excrement. Until recently, there was nowhere else to put it. It was here that the Irish doctor fought his campaign, building the slum’s first public toilet.

“It’s a big area of Kampala“, says Clarke “But it had been neglected for years… I just got fed up with the lack of leadership. I said to some people ‘What if I ran for this position?’ People said: ‘If you want to, you can try, you won’t succeed.’ I thought, if I’m going to point out all these ills of other people, and people not taking leadership, then if I have the opportunity to do it, I should do it myself. It’s my moral responsibility.”

Politics here is plagued by graft. The World Bank cites corruption as one of the greatest threats to Uganda’s development. It’s not unknown for candidates at local elections to hand out envelopes stuffed with cash, and some voters turned up to Clarke’s rallies expecting to be bribed, but left empty-handed. Six other candidates were running, including the incumbent, Moses Kalungi, an outspoken entrepreneur who refers to himself as “the Bill Gates of Uganda”.

Inevitably, Clarke’s Irishness became an issue, despite the fact he has held dual Irish-Ugandan citizenship for several years. Kalungi, in particular, focused on his opponent’s race as a weakness, accusing him of being incapable of understanding his constituents.

“As a foreigner… I don’t think he has the capacity to handle all the problems of local government”, says Kalungi. “In order to become a local leader, you must know the culture of the local people. You must be conversant in the local languages, their characters and behaviours.”

Richard Wanamwa, a journalist with the Daily Monitor, followed the campaign. He says that in Uganda, a country with far fewer tribal tensions than its neighbours, voters are more focused on results than on race. “At the start, people were saying ‘he can’t speak the local language’, but that became a non-issue. Most of the politicians here promise heaven on earth but they don’t deliver. He didn’t promise many things, but he was results-oriented.

His campaign was quite unique in the sense that he didn’t buy votes, he didn’t distribute money at all, he was only concerned with the wellbeing of the people.”

Every day, council workers can be seen clearing piles of rubbish out of the deep storm drains by the side of the road. In the past, when the drains were filled with rubbish, Namuwongo flooded regularly during the rainy season, killing some residents. “My postgraduate training was in public health, and this is all public health,” says Clarke “If you get flooding and garbage, it’s the cause of epidemics — you get dysentery, you get cholera.” Bureaucracy and budgets mean there are limits to what can be done, even on a basic level. The garbage truck being piled high with rubbish on the Kisugu road is the mayor’s own — a last resort after waiting too long for council trucks to be fixed.

Clarke was already well-known in the capital through a combination of good works, a sharp business sense and a flair for self-promotion. The hospital he founded is a landmark in the city, and he has had a column in the government-owned national paper, the New Vision, for several years. He sees his political work as an extension of his medical practice, and his role as providing basic services to better public health. He doesn’t turn his nose up at profit either, and is proud to be seen as an investor rather than as a donor. This attitude attracts criticism from old friends in the North, and puts him at odds with the expatriate aid community here.

In his book, How Deep is this Pothole?, he argues that years of massive development aid has had a corrosive influence in Uganda, bloating the civil service, choking the private sector, and creating a system dependent on handouts. He’s not alone in this, but donors disagree. Irish Aid has been present in Uganda since 1994. They point to the country’s transformation from a failed state in the mid-80s to a relatively stable economy, with an average annual growth rate of over 7% in the past decade, as proof that the current aid strategy works.

Clarke divides his time between politics and running International Hospital Kampala, along with a number of other business and charity interests.

The 100-bed private hospital began as a greenfield site in 2005, when Clarke decided to move from the provincial clinic he ran as a missionary and settle full-time in Kampala. As the country returned to stability after the years of civil war, he saw an opening for private healthcare amongst the growing middle class.

The project was financed with profits from an insurance company he started, along with a million-dollar bank loan, and continued piecemeal over the following years. Undaunted by a lack of funds and expertise, Clarke got personally involved in all aspects of the construction.

It was in this hospital that the first open-heart surgery in Uganda was performed in 2007, on a 13-year-old boy. Clarke prides himself on the fact that, apart from a Ghanaian-British surgeon, all of the team involved were his own Ugandan hospital staff. “I do have a real desire to see Uganda develop, and to see this country which has great potential — see some of that potential materialise. If I see patients for 30 or 40 years and then I die, then all that dies with me. We’re building up the facilities, and seeking to improve standards and then it can go on and build.”

The journey from South Armagh to Kampala began with Clarke’s faith. In his mid-30s, married with three young children and a successful practice, Clarke felt a growing dissatisfaction with middle-class Irish life. Inspired by the stories of missionaries, he decided to visit Uganda with a local church group.

In 1987, Uganda was coming to the end of a brutal bush war, which itself had followed eight years of repression under the dictatorial regime of Idi Amin. Yoweri Museveni’s bush soldiers had taken power in 1986, and the country was scarred by years of violence.

It’s estimated the Amin years took the lives of 300,000, and the five years of guerrilla war afterwards claimed an estimated 100,000. Clarke landed in what had been the epicentre of the fighting, a place known locally as the Luweero triangle, a couple of hours’ drive north-west of Kampala.

The area was mainly known at the time for the massacres that had taken place there during the bush war in the 1980s. After a brief visit, Clarke decided he had found a community where he could exercise both his faith and his medical skills.

His wife, Robbie, an English teacher, remembers his return from that first trip. “He was so moved that he wept. I had rarely seen my husband weep. When he said we were going to go there, I felt rather alarmed and thought: ‘My God, what on earth is he bringing me and our children to?’ Despite her doubts, she agreed to make the move, along with their children, Sean, Michael, and Lauren, then aged 11, 9, and 7 respectively.

The following year, they left for Uganda, arriving late at night in their new home in Kiwoko, then a tiny village in the Luweero triangle. Sean, the oldest, recalls the first time he saw their new home. “As we drove, the road just got worse, and worse, and worse, until we got to a little track. We were pushing through the bushes and eventually we got to this house, which might have been grand in its time, but it had completely disintegrated. There wasn’t any running water, there wasn’t any electricity, there were rats. I remember in candlelight trying to put together some beds, to get some sleep.”

Standing in front of the house, still standing, still dank and dirty, Robbie Clarke remembers her horror. “Ian had explained what it was like, and we had seen pictures, but nothing can prepare you for what it’s like… the middle of nowhere, deep in the African bush. I just thought: ‘How can I do this? How can I live here, how can I have my children here, how can I teach them here?’ Because I was their teacher as well as their mother.” She still shivers as she remembers the constant scratching sounds of the rats with which they shared their home.

Word went around quickly that there was a doctor in the area: Soon after their arrival, the family would wake to find a crowd of patients and curious onlookers queuing at their door. Pregnant women delivered on the front porch. In the shade of a tree in front of the house, Ian set up a clinic, consisting of two three-legged stools. Bosco Senoga, a lay reader at the church, volunteered as a translator.

When the rains came, a church a few minutes’ walk away provided shelter. The tiny vestry became a consulting room, shared with a colony of bats.

The pharmacy was in an old suitcase. Bosco and other church workers were trained in pharmaceuticals, dressings, blood transfusion. A motley medical team of 15 volunteers was soon dealing with 200-300 patients a day.

War casualties still arrived; malnourished guerrilla fighters came from the bush with bullet wounds. One patient had been mauled by a lion. There was no lack of help: The pastor, Reverend Livingstone Bataganya, enthusiastically vaccinated the rows of children lined up outside the church, and at times combined his two roles by whipping out his robes and conducting an impromptu service during a clinic. One day, he led the doctor through the bush.

Barely visible in the tall elephant grass were the foundations of a school, an Amin-era project that had been abandoned. Using bricks salvaged from buildings destroyed in the war, they began to build a proper clinic.

A foundation set up following the death of a close family friend provided finance; the rest was improvisation. Locals grew accustomed to the sight of the reverend and the doctor ferrying planks of wood to the building site on their heads.

As Clarke’s medical practice grew, his family settled in their new home. Unlike their mother, who would struggle for years with the isolation and tough living conditions, the three children took to life in Kiwoko immediately. No longer going to school every day, they flourished in their new atmosphere.

“I found it all very exciting,” Sean remembers. “We were running round the bush…. I used to skin snakes, I used to run around with a machete — you don’t get to do that as a kid in Northern Ireland — at least not without being arrested.”

The new clinic would have to deal with one of the greatest challenges Uganda had ever faced. By the late 1980s, the country was being devastated by what was considered to be the worst Aids epidemic in the world. It was estimated that, in some parts of Uganda, up to 30% of the population was affected by the disease. Before the development of antiretroviral drugs, a diagnosis of HIV meant certain death.

As the first rapid tests came out, both patients and staff at the Kiwoko clinic were tested. Many turned out to be positive. The family lost some of their closest friends, including John Ando, who had helped them settle when they arrived in Kiwoko, working tirelessly on every project and helping the Clarke children adjust to African life.

Despite the hardships of the Luweero years, the family remembers the place with great affection. Sean still lives in Uganda, where he works as a manager for the 10 medical clinics around the country owned by his father. Lauren is a nurse and a new mother living in Ireland, and Michael runs a hotel in Zanzibar. Sean says he never regretted the move to Africa. “I really value my experiences growing up. It’s hard going back into Northern Ireland. My life experiences are so different to what my peers’ experiences have been, but I’m really glad I’ve had those experiences. They’ve given my life colour.”

Reflecting on their past life in the North, his father has similar sentiments. “Life was more grey than it is here — everything here is in glorious technicolour”.

For now, Clarke is circumspect about his future in politics, but journalist Richard Wanamwa says there are bigger things to come. “He matters in the political hierarchy of the city. I get the response from people that he’s headed for being lord mayor of Kampala.”

When asked if Clarke’s nationality might hold him back, he shakes his head and answers firmly: “He is a Ugandan.”